General Info
Windsor RX and Windsor RX Plus prescription drug plans are products of Windsor Health Plan, Inc. Windsor Health Plan, Inc. has a contract with the Centers for Medicare & Medicaid Services (CMS), the government agency that runs Medicare, to provide Medicare prescription drug coverage to Medicare beneficiaries within our approved service areas. (To see complete service area and benefits information for all Windsor plans go to WindsorExtra.com). One way for Medicare beneficiaries to receive prescription drug coverage is to stay with Original Medicare and enroll in a stand alone Medicare Prescription Drug Plan, (PDP). Windsor RX and Windsor RX Plus, cover every Medicare approved generic drug or its generic/therapeutic equivalent. Windsor RX and Windsor RX Plus plans also offer low copays and provide coverage through the gap (or ?donut hole?).
When to enroll:
The Initial Enrollment Period for Part D (IEP for Part D) is the period during which you are first eligible to enroll in a Part D plan. In general, an individual is eligible to enroll in a Part D plan when he or she is entitled to Part A or enrolled in Part B, and permanently resides in the service area of a Part D plan. Individuals eligible for Medicare prior to age 65 (such as for disability) will have another Initial Enrollment Period for Part D based upon attaining age 65.
Open Enrollment:
Each year Medicare provides an ?open enrollment period? so that beneficiaries can switch plans or sign up for the first time. This year???s open enrollment time frame is from November 15 to December 31, 2006.
Can anyone enroll?
If you are enrolled in a Medicare Advantage (MA) coordinated managed care plan (HMO or PPO) or an MA private fee for- service (PFFS) plan that includes Medicare prescription drugs, you may not enroll in a PDP unless you disenroll from the HMO, PPO, or PFFS plan. Enrollees in a PFFS plan that does not provide Medicare prescription drug coverage, or an MA Medical Savings Account (MSA) plan, may enroll in a PDP. Enrollees in an 1876 Cost plan may enroll in a PDP.
No matter which Windsor stand alone drug plan you join, you may still keep your Original Medicare. Another choice you have is to join a Windsor Medicare Advantage and Prescription Drug (MA-PD) plan for all of your medical and prescription drug needs. You can learn more about all of the plans that Windsor offers at http://www.windsorextra.com, or call us @; 1-800-316-2273 (or TTY for the hearing impaired 1-800-848-0298) from 7:00 a.m. to 8:00 p.m. Central Standard Time, 7 days a week.
You can also contact Medicare for more information at http://www.medicare.gov on the web
or call; 1-800-MEDICARE (1-800-633-4227).
TTY users should call 1-877-486-2048.
You were also sent a booklet by mail called Medicare and You 2007. That booklet tells you about the different choices you have to receive your Medicare medical and prescription drug benefits.
If You Have Employer or Union Prescription Coverage:
If you have prescription drug coverage from a former or current employer or union, contact your benefits administrator before you make any changes to
your drug coverage. If you join a Medicare Prescription Drug Plan or Medicare Advantage Plan, you and your family may lose your employer or
union coverage.
- You must complete a Windsor RX or Windsor RX Plus enrollment form and mail it to us, or;
- Enroll by phone with a Windsor enrollment counselor, or;
- Enroll online on the Windsor website
- Enroll through Medicare by calling 1-800-MEDICARE (1-800-633-4227)
or toll free at 1-800-633-4227;
(for TTY/TDD users call 1-877-486-2048),
24 hours-a-day/ 7 days-a-week;
or go to the Medicare website: http://www.medicare.gov. - Have a legal authorized representative enroll you through one of the above methods.
Even if you are enrolled in another Windsor plan and you are electing another one of Windsor plans you must complete a new enrollment election. Call us at 1-800-316-2273 (or TTY for the hearing impaired 1-800-848-0298) from 7:00 a.m. to 8:00 p.m. Central Standard Time, 7 days a week and we can send you the appropriate plan to plan enrollment form.
Once Windsor receives notice from Medicare we will send you a notice of confirmation of enrollment, rejection of enrollment, or a denial of enrollment and the reason.
What drugs do Windsor RX and Windsor RX Plus plans cover?
Windsor has a list of covered drugs called a ?formulary.? Our formularies include at least two drugs (and in some cases all drugs) in all classes of drugs most commonly prescribed to people with Medicare. This makes sure that people with different medical conditions can get the treatment they need. The list can change during the year because drug therapies change, and new drugs and medical knowledge become available. If you are affected by the change, your plan will notify you at least 60 days before the formulary changes. If there is a formulary change that affects a drug you take, in most cases, it will
still be covered for you until the end of the year.
- Are prescription drugs covered?
- Are my prescription drugs covered?
- What are the out-of-pocket costs?
What pharmacies can I go to? Windsor RX or RX Plus plans provide prescription drug benefits through Medicare-certified pharmacies. Windsor has an extensive list or ?directory? of network pharmacies. This list is posted on this website. It is also mailed to you when you become a Windsor member. A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by Windsor Medicare Extra. In most cases, your prescriptions are covered under Windsor Medicare Extra only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one, you are not required to continue going to the same pharmacy to fill your prescription, you can go to any of our network pharmacies. To get current information about Windsor?s network pharmacies in your area, please visit our Web site at http://www.WindsorExtra.com, or call our Member Services department at 1-800-316-2273, 7 a.m. ? 8 p.m., Central Time, 7 days a week. (TTY/TDD Users should call 1-800-848-0298.)
To find a pharmacy near you in the pharmacy directory, you should first locate the type of pharmacy you need. The three types of pharmacies include retail, mail order and long term care. The directory is then arranged in alphabetical order by county, then by city, and finally then by zip code. We have also indicated if the pharmacy is open 24 hours a day and if the pharmacy will accept 90 day supply maintenance prescriptions. Or, you can visit our Web site at www.WindsorExtra.com or call our Member Services at 800-316-2273, 7 a.m. ??? 8 p.m. Central Time, 7 days a week. (TTY/TDD Users should call 800-848-0298.)
Mail order:
We also offer a mail-order program that will allow you to have drugs sent directly to your home. To get order forms and information about filling your prescriptions by mail, call ProCare Rx at 800-662-0586. Please note that you must use the Windsor Medicare Extra mail order service. Prescription drugs that you get through any other mail order service are not covered.
Getting Help Paying for the Costs of Prescription Drug Coverage:
If you have Medicare and have limited income and resources, you may qualify for extra help paying for prescription drugs. The low income subsidy is extra help with prescription drug costs for Medicare-eligible individuals whose income and resources are limited. This help is in the form of payments to the Part D Plan that you join. Persons eligible for Medicaid, Supplemental Security Income (SSI), or a Medicare Saving Program qualify for the extra help automatically and do not need to apply. All others may apply with the Social Security Administration (SSA) by mail, by telephone, on the Internet at http://www.socialsecurity.gov or in person at a community event or an SSA office. Applications may also be filed at a local Medicaid office.
Beneficiaries can also access the Medicare web site for requirements for the low income subsidy: http://www.cms.hhs.gov/medicarereform/lir.asp, or call the Medicare Service Center @ 1-800-MEDICARE (1-800-633-4227) TTY Toll-Free: 866-226-1819.
Are my drugs covered? A formulary is a list of drugs selected by Windsor RX and Windsor RX Plus plans for coverage by our plans. This formulary is reviewed and approved by Medicare. Windsor Medicare Extra plans will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Windsor network pharmacy, and other plan rules are followed. Windsor may add or remove drugs from the formulary during the year. We will provide 60-day notice regarding removal or change in the preferred or tiered cost-sharing status of a Part D drug.
Appeals and Grievances:
Members of Windsor Medicare Extra plans have the right to appeal any decisions we make related to your medical or prescription drug benefits, including but not limited to a denial, termination, payment, or reduction of services. For more information on the Windsor?s grievance and appeal process, contact Windsor Medicare Extra Member Services at 1-800-316-2273 (or TTY for the hearing impaired 1-800-848-0298) from 7:00 a.m. to 8:00 p.m. Central Standard Time, 7 days a week. You can also access the grievance and appeal process on this website. Simply click on the icon for ???Exceptions and Appeals.?
Medication Therapy Management Program: Windsor Health Plan, Inc. recognizes the importance for monitoring medications to prevent potential adverse events and establishing best practices outcomes. Our plans have a Medication Therapy Management Program that is designed to be patient focused, aimed at improving therapeutic outcomes and identifying best practices. This process will involve a Medication Therapy Management Team consisting of pharmacy, case management, disease management, customer service, provider relations and utilization management staff with oversight provided by the Chief Medical Officer. The program consists of identifying beneficiaries who are eligible for the program and communicating with the member and providers, developing interventions, promoting educational opportunities and working directly with the member to help them improve their health related outcomes.
Important Contacts:
Centers for Medicare & Medicaid Services (CMS)
7500 Security Blvd.
Baltimore, MD 21244-1850
1-800-633-4227, TTY 1-877-486-2048 or
1-877-7SAFERX (1-877-772-3379)
24 hours a day; seven days a week
Medicare
1-800-MEDICARE (1-800-633-4227)
TTY Toll-Free: 866-226-1819
http://www.medicare.gov
Social Security Administration – Office of Public Inquires
Windsor Park Blvd.
6401 Security Blvd.
Baltimore, MD 21235
1-800-325-0778
TTY 1-800-325-0778
7 a.m. ??? 7 p.m.
http://www.ssa.gov/
SHIP – Seniors Health Insurance Information Program
Tennessee:
Commission on Aging and Disability
Toll Free (877) 801-0044
TDD: (615) 532-3893
Arkansas:
Seniors Health Insurance Information Program
Arkansas Insurance Department: (800) 224-6330
Alabama:
SHIP Office : (800) 243-5463
Mississippi:
MS Insurance Counseling and Assistance Program :
(800) 948-3090
(601) 359-4929
